Bonds, bounds, and burdens at the borders

Recent infectious disease outbreaks highlight the importance of competent professionals with expertise on public health preparedness and response at airports. The availability of a competency profile for this workforce supports efficient education and training. Although competency profiles for infectious disease control professionals are available, none addresses the complex airport environment. Therefore, the main aim of this study is to develop a competency profile for professionals involved in infectious disease preparedness and response at airports in order to stimulate and direct further education and training. We developed the competency profile through the following steps: 1) extraction of competencies from relevant literature, 2) assessment of the profile in a national RAND modified Delphi study with an interdisciplinary expert group (n = 9) and 3) assessment of the profile in an international RAND modified Delphi study with an airport infectious disease management panel of ten European countries (n = 10). We systematically studied two competency profiles on infectious disease control and three air transport guidelines on event management, and extracted 61 relevant competencies for airports. The two RAND modified Delphi procedures further refined the profile, mainly by specifying a competency's target group, the organizational level it should be present on, and the exact actions that should be mastered. The final profile, consisting of 59 competencies, covers the whole process from infectious disease preparedness, through the response phase and the recovery at airports. We designed a profile to support training and exercising the multidisciplinary group of professionals in infectious disease management in the airport setting, and which is ready for use in practice. The many adaptations and adjustments that were needed to develop this profile out of existing profiles and air transport guidelines suggest that other setting-specific profiles in infectious disease control are desirable.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.

Promoting synergies between clinical medicine and public health.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

BackgroundThe rapid evolution of social media in recent years has increased public exposure to suicide. While research has highlighted concerns about the role of social media in facilitating harmful discourse and imitative suicidal behaviour, there is a wide gap in our understanding of the impact of social media exposure in the aftermath of a suicide, and no research to our knowledge from preventive public and mental health perspectives. This qualitative study explored the experiences of public and mental health professionals in relation to social media exposure following a suicide. The study aimed to (1) Better understand social media risks from a public health perspective; (2) Provide insights for public health policy and strategy to enhance suicide prevention efforts and inform guidance for responding.MethodsIn-depth interviews were conducted with 10 purposively sampled public and mental health professionals based on their roles in crisis response, suicide prevention, and digital monitoring. Data were collected through semi-structured interviews, focusing on their experiences of responding to suicide-related risks on social media, including the spread of information across platforms, public engagement with content, impact, and intervention challenges. Data were analysed using thematic analysis to identify emerging themes.ResultsFour key themes emerged: (1) The communicative ecology of social media (where the public act as content purveyors, rapidly disseminating varied and often unregulated narratives); (2) Harmful effects (including the copycat effect and toxic discourse); (3) Positive effects (where protective discourse and moderation offer harm reduction opportunities); and (4) Challenges in intervention (including content moderation difficulties and algorithmic biases that amplify harmful narratives).ConclusionFindings highlight the need for improved content moderation, public health-led digital monitoring, and education on safe social media use. Strengthening real-time suicide surveillance, improving collaboration with social media platforms, and promoting public awareness of digital literacy are critical to mitigating risks and ensuring social media supports suicide prevention efforts. As digital communication continues to evolve, proactive public health strategies will be essential in safeguarding vulnerable individuals.

The Ethics of Public Health

The growing importance of public health is evidenced by its increasing responsibilities. Public health was historically known for its contribution towards reduction and control of infectious diseases through such efforts as environmental sanitation (by securing safe air and water), hygienic practices, the elimination of smallpox and polio (through immunization), and reduction of overcrowding. As chronic diseases replaced infectious diseases as the leading causes of death, public health shifted its focus towards health promotion programs such as lifestyle changes in diet, tobacco, and exercise, to prevent contemporary health threats including cardiovascular disease, type-2 diabetes, and obesity. In recent years, as a result of a series of natural calamities such as Hurricanes Katrina and Rita and the spread of severe acute respiratory syndrome (SARS), and human-created threats such as 9-11 attack and the possibility of terrorist attacks involving chemical, biological, radiological, or nuclear weapons, public health has again assumed center stage and been called upon to handle these emerging threats. However, little is known about how the public health system can be organized to effectively and efficiently handle the modern-day threats of infectious and chronic diseases, and environmental disruptions, both natural and human-created. Moreover, public health remains marginal in many countries' health care system, particularly the US where public policy has rarely emphasized public health. There remains a deep lack of appreciation of what public health can accomplish towards improving population health.

Strengthening the BTWC: The role of the Biological and Toxin Weapons Convention in combating natural and deliberate disease outbreaks

Is Africa prepared for tackling the COVID-19 (SARS-CoV-2) epidemic. Lessons from past outbreaks, ongoing pan-African public health efforts, and implications for the future

Objective-Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population.Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers.To address this gap in the literature this study addresses the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history?Methods-Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history.Results-Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury.Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems.Conclusions-The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers.Also, research on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons should be accelerated.

Bioethics emerged at a time when infectious diseases were not a major concern. Thus bioethics never had to develop a normative framework sensitive to situations of disease transmission. The Patient as Victim and Vector explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different in infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others. Bioethics has failed to see one part of this duality, they document, and public health the other: that the patient is both victim and vector at one and the same time. The Patient as Victim and Vector is jointly written by four authors at the University of Utah with expertise in bioethics, health law, and both clinical practice and public health policy concerning infectious disease. Part I shows how the patient-centered ethic that was developed by bioethics- especially the concept of autonomy- needs to change in the context of public health, and Part II develops a normative theory for doing so. Part III examines traditional and new issues involving infectious disease: the ethics of quarantine and isolation, research, disease screening, rapid testing, antibiotic use, and immunization, in contexts like multi-drug-resistant tuberculosis, syphilis, hepatitis, HIV/AIDS, and HPV. Part IV, beginning with a controversial thought experiment, considers constraint in the control of infectious disease, include pandemics, and Part V 'thinks big' about the global scope of infectious disease and efforts to prevent, treat, or eradicate it. This volume should have a major impact in the fields of bioethics and public health ethics. It will also interest philosophers, lawyers, health law experts, physicians, and policy makers, as well as those concerned with global health.

This article explores the importance and complexity of finding a balance between infectious disease prevention and control and patients’ privacy. Using COVID-19 and AIDS as case studies, the article analyzes how this balance can be achieved under the legal framework and presents relevant legal and ethical considerations. The article points out that although Chinese law has strict protections for patients' privacy rights, moderate adjustments to private rights may be necessary to protect public health during public health emergencies. In exploring the issue of privacy rights in the prevention and control of the new coronavirus, the article emphasizes the balance between personal information protection and public health safety and proposes strategies such as data protection and the principle of minimizing information. At the same time, by analyzing the conflicts between the right to privacy and the right to life and health in AIDS prevention and control, the article demonstrates the role of the law in resolving these conflicts and suggests that the balance between these two rights should be more clearly defined in medical practice. The conclusion of article emphasizes the need to continually adjust and balance the relationship between infectious disease control and patient privacy based on legal, technological, and educational considerations to safeguard both individual dignity and public health security.

Public health is defined as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.’ (1920, C.E.A. Winslow)(1) It is concerned with threats to the overall health of a community based on population health analysis. There are two distinct characteristics of public health, firstly it deals with preventive rather than curative aspects of health and secondly it deals with population-level, rather than individual-level health issues. The goal of public health is to improve lives through the prevention and treatment of disease. The United Nations' World Health Organization defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’(2) Public health is generally seen as a modern concept, although it has roots in history. For centuries, it was recognized that certain societal elements (e.g. poor waste disposal) led to communicable diseases. Governments allowed the development of public health policies and programs to gain some understanding of the causes of disease and thus ensure social longevity. This ordered approach lead to a drop in the prevalence of infectious diseases in the developed world through the 20th century. Public health then began to put more focus on the perceived ‘modern’ chronic diseases such as cancer and heart disease. During the 20th century, the dramatic increase in average life span is widely credited to public health achievements, such as vaccination programs and control of infectious diseases, and other initiatives designed to decrease chronic disease. Meanwhile, the developing world remains plagued by largely preventable infectious diseases, exacerbated by malnutrition and poverty. Modern public health is often concerned with addressing determinants of health across a population, with clinicians influencing individual behaviour change. There is recognition that our health is affected by many factors including geography, genetics, and social/economic status. Today, most governments recognise the importance of public health programs in reducing the incidence of disease, although public health generally receives significantly less government funding compared with other areas of medicine. Important public health issues facing the world include HIV/AIDS. Antibiotic resistance is another major concern, leading to the reemergence of diseases such as Tuberculosis. Another major public health concern is diabetes. Governments of all nations need to focus more on proactive solutions to reduce overall health care spending on treatment. Many of the issues discussed above strike a chord within our world of preventing or managing wounds. Acute, Traumatic and Chronic wounds affect millions of patients globally, particularly older individuals. Chronic wounds are frequently long term, painful and debilitating, resulting in extreme loss of quality of life for sufferers. For many patients living with non-healing wounds, amputation of an affected limb may be the only option. Wound prevention and treatment represents a growing cost to healthcare systems across the world, because of the increasing incidence of acute and chronic wounds which can consume large amounts of resource and only heal after a prolonged period of care. Our last editorial focused on the emergence of wound care as a clinical specialty and highlighted the potential ‘real’ costs of chronic wounds. In the UK alone, conservative costs to the UK National Health Service are estimated at £2–3 billion per year in direct costs and in the United States, chronic wounds affect 6.5 million patients which is estimated to cost in excess of US$25 billion annually (3). The burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from ‘highly branded’ diseases such as diabetes and obesity (recognised public health issues). Yet the issue receives little attention from the media, policy makers and research funding agencies. Why-when chronic wounds are such a societal and financial burden-is it allowed to continue? Kerth Harding, Editor-in-Chief Douglas Queen Editor

Infections acquired in hospitals have been recognized as a significant cause of morbidity and mortality since before the era of Semmelweis and Lister. Hospital isolation and precaution procedures have evolved along highly individualistic lines depending on the facilities, patient population and the degree of concern regarding nosocomial infections at a particular hospital. In recent years, a number of valuable manuals which offer details of isolation and precaution techniques as well as recommendations for the hospital control of particular infectious diseases have become available. These include: 1. Public Health Service, U. S. Department of Health, Education and Welfare: Isolation Techniques Used in Hospitals. Washington, D.C.: U.S. Government Printing Office, 1970. 2. Report of the Committee on Infectious Diseases, ed. 16. Evanston, Illinois: American Academy of Pediatrics, 1970. 3. Infection Control in the Hospital, ed. 2. Chicago: American Hospital Association, 1970. 4. Benenson, A. S. (ed.): Control of Communicable Diseases in Man, ed. 11. New York: American Public Health Association, 1970. 5. Top, F. H. (ed.): Control of Infectious Diseases in General Hospitals. New York: American Public Health Association, 1967. In an attempt to synthesize these recommendations into a more easily utilized form, the following alphabetical listing of diseases and conditions has been developed by members of the Infections Control Committee at the Children's Hospital Medical Center. It should be stressed that these are guidelines based on current understanding of the natural history and epidemiology of certain infections. In our hospital, modifications are frequently necessary due to heavy demand for the limited isolation facilities.

Tackling COVID-19 in the Eastern Mediterranean Region